Còlics equins : millora de la diagnosi per als casos més greus

Un dels problemes més freqüents que pateixen els cavalls són els anomenat còlics equins, que poden tenir diferents nivells de gravetat. Un grup de científics de la UAB ha realitzat un estudi clínic amb 115 equins, emprant els dos mètodes d'anàlisi descrits per al plasma del cavall. El mètode simplificat d'ions forts de Constable s'ha erigit com el més eficaç per detectar els processos més greus.Uno de los problemas más frecuentes que sufren los caballos son los denominados cólicos equinos, que pueden tener diferentes niveles de gravedad. Un grupo de científicos de la UAB ha llevado a cabo un estudio clínico con 115 equinos, utilizando los dos métodos de análisis descritos para el plasma del caballo. El método simplificado de iones fuertes de Constable se ha revelado como el más eficaz para detectar los procesos más graves

Metabolic and Endocrine Profiles in Sick Neonatal Foals Are Related to Survival

Background : $b sick neonatal foals suffer from a variety of endocrine and metabolic derangements that may be related to outcome. There are several hepatic and lipid metabolism blood markers that have never been assessed in neonatal foals. Objectives: Assess panel of endocrine and metabolic variables in group of sick and healthy neonatal foals in order to describe their relationship with diagnosis and survival. Animals: All neonatal foals referred to Unitat Equina-Fundacio Hospital Clınic Veterinari during 3 consecutive foaling seasons and a group of healthy foals. Methods: Observational prospective study. Blood samples were obtained on admission and, when possible, after 24-48 h of hospitalization and immediately before discharge or death. Measured variables were triglycerides, nonsterified fatty acids, glucose, creatinine, urea, c-glutamyltransferase, glutamate dehydrogenase (GLDH), insulin, cortisol, bile acids, and adrenocorticotropic hormone (ACTH). ACTH/cortisol and glucose/insulin ratios were calculated. Results: Urea, creatinine, and cortisol had median concentrations in septic and nonseptic foals 2- to 8-fold higher than in the control group (P < .001). Median ACTH concentration in the septic group was approximately 4 times higher than in nonseptic and control foals (P < .001). ACTH/cortisol ratio was significantly lower in sick foals compared to control foals (P < .001). A score was designed including creatinine, GLDH, and cortisol. When 2 of these variables were altered (P < .001), the foal had 32 times more risk of dying (OR, 31.7; 95% CI, 7.7-130.3). Conclusions and Clinical Importance: Plasma creatinine, GLDH, and cortisol should be determined in sick newborn foals on admission because of their association with survival

Association of admission plasma D-Dimer concentration with diagnosis and outcome in horses with colic

Background: Coagulopathies detected in horses with gastrointestinal problems seem to be associated with poor outcome. Plasma D-Dimer concentration is a sensitive test for assessing coagulopathies. Hypothesis: Plasma D-Dimer concentration tested on admission is related to diagnosis and outcome in horses with colic. Animals: Four hundred and ninety three horses referred for evaluation of abdominal pain. Methods: Prospective observational clinical study. Horses were grouped according to diagnosis (medical and surgical intestinal obstructions, ischemic disorders with and without intestinal resection, enteritis, peritonitis), outcome (survivors, nonsurvivors), and number of coagulopathies (normal profile, 1 or 2 coagulopathies, subclinical disseminated intravascular coagulation [DIC]). Blood samples were collected on admission and plasma D-Dimer concentration, clotting times (PT and aPTT), and antithrombin activity were determined. Positive likelihood ratios (LR1) were calculated for evaluation of D-Dimer cut-off values, which were later tested in a logistic regression model. Results: Horses with enteritis or peritonitis had significantly (P o .001) higher plasma D-Dimer concentrations and more severe coagulopathies on admission than horses with other diagnoses. Nonsurvivors also had significantly (P o .001) higher plasma D-Dimer concentrations at presentation than did survivors, and those horses with subclinical DIC on presentation had an odds ratio (OR) 8.6 (95% confidence interval [CI], 3.3-22.5, P o .001) for nonsurvival. Finally, D-Dimer concentrations 44,000 ng/mL had a LR1 of 5.9 and an OR 8.8 (95% CI, 4.5-17.1, Po .001) for nonsurvival. Conclusion and Clinical Importance: Plasma D-Dimer concentration measured on admission can be used to facilitate diagnosis and outcome prediction in horses with colic. A potential cut-off value for nonsurvival was found at approximately 4,000 ng/m

Low-molecular-weight heparin dosage in newborn foals

Background: Heparin is used in humans as prophylaxis of hypercoagulable states and disseminated intravascular coagulation (DIC). However, babies need a higher heparin dose than do adults. Septic neonate foals are at high risk of hypercoagulable state and DIC, and there is limited objective information about heparin dose for equine neonates. Objective: To assess whether neonate foals require higher dosages of low-molecular-weight heparin (LMWH) than adults. Animals: Eighteen healthy and 11 septic neonate foals. Methods: Experimental and clinical studies. Firstly, healthy foals were randomly distributed in 2 groups, 1 receiving 50 IU/ kg SC of dalteparin and the 2nd group receiving 100 IU/kg SC of dalteparin, once daily for 3 days. Blood samples were collected before and 3, 6, 27, and 51 hours after the 1st LMWH administration. Plasma antifactor-Xa activity was measured, together with hemostatic and hematologic parameters used to assess the risk of bleeding. Subsequently, septic foals were treated blindly either with placebo (saline) or 100 IU/kg of dalteparin for 3 days. Plasma antifactor-Xa activity and other hemostatic parameters were determined before and after treatment. Results: Plasma antifactor-Xa activity in healthy foals was below prophylactic activity when using the adult dosage (50 IU/ kg), whereas prophylactic activities were achieved when using the double dosage (100 IU/kg). No hemorrhagic events and erythrocyte-related complications were observed with either dosage. In the clinical study, only 4/6 septic foals had plasma antifactor-Xa activity adequate for prophylaxis. Conclusions and Clinical Importance: Equine neonates require higher dosages of LMWH compared with adults to reach prophylactic heparinemia

Presumptive spontaneous hemothorax associated to thymic involution in a dog with steroid responsive meningitis-arteritis (SRMA)

Altres ajuts: acords transformatius de la UABObjective: To describe an unusual case of spontaneous hemothorax resulting from thymic involution in a dog with suspected acquired bleeding dyscrasia associated with steroid-responsive meningitis-arteritis (SRMA). Case description: A 6-month-old spayed female Golden Retriever was referred due to the sudden onset of lethargy, fever (pyrexia), loss of appetite (anorexia), and moderate neck pain. These symptoms emerged six days after an ovariohysterectomy performed by the primary veterinarian. Upon admission, the patient exhibited pale mucous membranes, tachycardia (180 bpm), bilateral muffled heart sounds and tachypnea. Abdominal and thoracic point-of-care ultrasound (POCUS) were performed and revealed bilateral pleural effusion. Due to the patient's unstable condition, emergent thoracocentesis and transfusion of packed red blood cells was required. The initial work-up performed included a complete blood cell count (CBC), biochemistry profile, venous blood gas and coagulation panel (PT, APTT, fibrinogen). Pleural effusion analysis was compatible with hemothorax. Bloodwork was unremarkable including the initial coagulation panel. Further coagulation test was performed including buccal mucosal bleeding time, viscoelastic-based clot detection tests (TEG) and Von Willebrand factor antigen measurement. TEG revealed marked hyperfibrinolysis. Angiostrongylus vasorum and 4DX snap test were performed and yielded a negative result. Thoracic CT scan revealed the presence of a soft tissue-attenuating mass in the ventral mediastinum, thymic involution, and enlargement of the sternal and mediastinal lymph nodes. Therapy with tranexamic acid and corticosteroids at anti-inflammatory doses was initiated. Marked clinical improvement was observed within 24 hours, and after three days of hospitalization the patient was discharged. One month later, the dog was referred again for acute pyrexia, hyporexia, and neck pain which progressed to non-ambulatory tetraparesis. Neurological examination was compatible with C6-T2 lesion. MRI and cerebrospinal fluid analysis were performed and revealed a final diagnosis of steroid-responsive meningitis-arteritis (SRMA) with associated intramedullary hemorrhage. Corticosteroids were started again, and the patient showed a dramatic improvement over the next 24 hours. Three weeks after the diagnosis, the dog returned to a clinically normal state. The treatment was gradually tapered over the following months, guided by regular neurological and clinical examinations and CRP measurements, without any relapses. New or unique information: To the best of the author's knowledge, this is the first documented case of a dog experiencing spontaneous hemothorax as a result of thymic hemorrhage/involution which, in the absence of other identifiable diseases, was attributed to a hyperfibrinolytic state induced by a severe inflammatory disease such as SRMA

Pharmacoepidemiologic perspective on treatment with antidepressants between 1999 and 2005

NamenČ Namen raziskave je pregled uporabe antidepresivov med leti 1999 in 2005. MetodeČ Porabo antidepresivov v Sloveniji smo analizirali s pomooejo podatkov o prodaji zdravil na ravni veledrogerij, ki smo jih pridobili iz sistema PharMIS za leta 1999-2005. RezultatiČ Med vsemi skupinami antidepresivov so se najveoe uporabljali Ćselektivni zaviralci prevzema serotoninaĆ, katerih uporaba je iz 2.411 DDD na 1000 prebivalcev v letu 1999 zrasla na 8.600 DDD v letu 2005. Uporaba Ćneselektivnih zaviralcev prevzema monoaminovĆ je pooeasi padala, uporaba Ćzaviralcev monoaminooksidaz tipa AĆ paje ostala nespremenjena, kljub sploøni rasti uporabe antidepresivov. Antidepresivi, ki spadajo v skupino Ćdrugi antidepresiviĆ so imeli v letu 20056,3- krat veoejo uporabo kot v letu 1999. Deleæ uporabe v bolniønicah je vletu 2000 znaøal 4,4%, leta 2005 pa 2,8%. Podatek za leto 1999 nelogioeno odstopa od osnovnega trenda in znaøa 2,7%. Podatki o prodaji antidepresivov veoeinoma sledijo podatkom o njihovi uporabi.AimsČ The present study aims to review the utilization of antidepressants between 1999 and 2005.MethodsČ The utilization patterns of antidepressants inSlovenia were analysed based on data obtained from wholesalers (PharMIS database) for the years 1999-2005. ResultsČ Among all the groups of antidepressants ĆSelective serotonin reuptake inhibitorsĆ were the most often used and accounted 2.411 in 1999 and 8.600 DDDsž1000 inhabitants in 2005. Utilization of ĆNon-selective monoamine reuptake inhibitorsĆ was slowly declining, while ĆMonoamine oxidase A inhibitorsĆ remained unchanged, despite the general rise in the use of antidepressants. Antidepressants that are classified as ĆOther antidepressantsĆ had a 6,3 times higher utilization in 2005 than in year 1999. The hospital share in the use of antidepressants accounted 4,4% in 2000 and 2,8% in 2005. The result for the year 1999, in regards to the trend in the following years, illogically accounts 2,7%. The sales data mostly follow the utilisation patterns

Identidad y excedente ideológico en el Quijote de Cervantes

Reasons for performing the study: Bacterial meningoencephalitis is a severe complication in septic foals and there is scarce and often unclear information in the equine literature. Objectives: To report the most frequent clinical signs, clinicopathological findings, causative agents, treatments given and outcome of a group of foals with confirmed bacterial meningoencephalitis. Methods: Foals aged < 6 months of age admitted to the Universitat Autonoma de Barcelona (2004-2009) with confirmed bacterial meningoencephalitis were retrospectively included in the study Diagnosis of bacterial meningoencephalitis was made by cerebrospinal fluid (CSF) culture, CSF analysis consistent with bacterial infection, observation of bacteria in CSF cytology or postmortem confirmation. Results: Nine neonates and one 5-month-old foal were included. The most frequently observed clinical signs were alterations in mental status (10/10), recumbency (8/10), weakness (8/10), abnormal pupillary light reflexes (6/10), decreased suckling-reflex (6/9), seizures and/or nystagmus (4/10). Common clinicopathological alterations included yperfibrinogenaemia (8/9), hyperlactataemia (7/7), and neutropenia (5/10) or neutrophilia (5/10). Most neonates (8/9) developed bacterial meningoencephalitis despite having a sepsis score near the cut-off value (median = 12). On CSF analysis, pleocytosis (9/9), increased total protein concentration (5/6) and intracellular bacteria (6/9) were detected. The most frequently isolated bacterium was Escherichia coil. Once bacterial meningoencephalitis was diagnosed, antimicrobial therapy was switched to third and fourth generation cephalosporins. Conclusions: The diagnosis of bacterial meningoencephalitis is established based on CSF analysis and culture. Clinical recognition of bacterial meningoencephalitis is difficult and can be easily overlooked. Moreover, severe sepsis is not necessary to develop bacterial meningoencephalitis

Energy expenditure of critically ill neonatal foals

Reasons for performing study: Nutritional support in critically ill neonatal foals is of great importance given their high metabolic rate and minimal stores of energy and protein. Nutrient requirements of healthy growing foals have been estimated based on daily milk intake; however, little is known about the resting energy expenditure (REE) of sick foals. Objectives: To determine REE in critically ill neonatal foals (sepsis and/or hypoxic-ischaemic encephalopathy [HIE] and compare this with REE in control foals. Methods: Critically ill newborn foals admitted to the Fundació Hospital Clinic Veterinari, Universitat Autònoma de Barcelona, Spain from March 2009 to February 2011 were included in this study. Healthy neonatal foals and foals with nonsystemic conditions were used as controls. Oxygen consumption and CO2 production were measured with a respiratory monitor connected to a tight fitting facemask and REE (kcal/kg bwt/day) was calculated with the abbreviated Weir formula. Measurements were performed within 24 h of admission and repeatedly during hospitalisation. Results: Twenty-seven foals were included (16 critically ill foals and 11 controls) and a total of 47 measurements were performed. In the critically ill, REE was reduced (mean +/- s.e. 49.5 +/- 2.1 kcal/kg bwt/day) on admission relative to the controls. In surviving foals (n = 5), REE before hospital discharge was not different (68.4 +/- 7.0 kcal/kg bwt/day) from control foals (64.8 +/- 2.7 kcal/kg bwt/day). Conclusions: REE was lower in critically ill foals upon admission (40-50 kcal/kg bwt/day) and normalised before hospital discharge (60-80 kcal/kg bwt/day). Potential relevance: Critically ill neonatal foals tolerating enteral feeding would receive approximately their REE when given 10% of their bodyweight in mare's milk daily. For sick neonates unable to tolerate enteral nutrition, provision of 50 kcal/kg bwt/day would be a reasonable goal for parenteral nutrition

Clinical findings in 10 foals with bacterial meningoencephalitis

Reasons for performing the study: Bacterial meningoencephalitis is a severe complication in septic foals and there is scarce and often unclear information in the equine literature. Objectives: To report the most frequent clinical signs, clinicopathological findings, causative agents, treatments given and outcome of a group of foals with confirmed bacterial meningoencephalitis. Methods: Foals aged < 6 months of age admitted to the Universitat Autonoma de Barcelona (2004-2009) with confirmed bacterial meningoencephalitis were retrospectively included in the study Diagnosis of bacterial meningoencephalitis was made by cerebrospinal fluid (CSF) culture, CSF analysis consistent with bacterial infection, observation of bacteria in CSF cytology or postmortem confirmation. Results: Nine neonates and one 5-month-old foal were included. The most frequently observed clinical signs were alterations in mental status (10/10), recumbency (8/10), weakness (8/10), abnormal pupillary light reflexes (6/10), decreased suckling-reflex (6/9), seizures and/or nystagmus (4/10). Common clinicopathological alterations included yperfibrinogenaemia (8/9), hyperlactataemia (7/7), and neutropenia (5/10) or neutrophilia (5/10). Most neonates (8/9) developed bacterial meningoencephalitis despite having a sepsis score near the cut-off value (median = 12). On CSF analysis, pleocytosis (9/9), increased total protein concentration (5/6) and intracellular bacteria (6/9) were detected. The most frequently isolated bacterium was Escherichia coil. Once bacterial meningoencephalitis was diagnosed, antimicrobial therapy was switched to third and fourth generation cephalosporins. Conclusions: The diagnosis of bacterial meningoencephalitis is established based on CSF analysis and culture. Clinical recognition of bacterial meningoencephalitis is difficult and can be easily overlooked. Moreover, severe sepsis is not necessary to develop bacterial meningoencephalitis